Leda`s Story And Her Investigation Into Microsurgery To Treat Lymphedema

Leda`s Lymphedema Story

I was diagnosed with grade 3 breast cancer in 2010. In January, 2011, ~3 months after the second mastectomy and removal of lymph nodes, I noticed the swelling of my right arm and hand. Lymphedema!

In March, 2011, I saw Dr Anna Towers, a lymphedema specialist in Montreal and Dorit Tidhar and Pamela Hodgson, physiotherapists. They were all extremely helpful. Because the Lymphedema was significant, I had to go through the motions. Compression started, with bandages at first. Seven bandages, 5 meters (!) long each – Comprilan, short-stretch. The shorter the stretch, the worse the handicap and invalidity… It lasted for ~5 months. By then my arm had lost some of its volume, and I started wearing a “Mediven” glove and sleeve. It was better than the bandages, that took me an hour to put on and off, but although it was smooth, it was way too stiff and unbending.

In November, 2011, ~4 months later, I had a bad infection in my arm, cellulitis. I woke up in the middle of the night, my arm was red and swollen and sore, and I had a fever of 39. The red had started from a spot I could see, where the sleeve was scraping the skin, and it was spreading outwards as I was watching… To make a long story short, I was at KGH with iv antibiotics for ~6 days, then oral antibiotics for another month. Once the swelling subsided, I started using a different brand of compression sleeve, “Juzo”. I am still using them, I like them much better.

No matter what, the compression itself is a big life-changer. As a professor working in cancer research at Queen’s, I used to do lots of labwork myself, especially cell culture, which requires sterile conditions and dexterity. This is impossible to do with a compression glove on. At least I have “sliders” now, to put the sleeve and glove on and off quickly, so that I can take them off for a few minutes, show my students what to do, then put them back on.

Still, I was always on the lookout for something better…

An article published in the winter 2017 edition of a magazine published by the Ohio State University Comprehensive Cancer Center -James Cancer Center and Solove Research Institute (OSUCCC – James) got my attention. It talks about surgical techniques pioneered at OSUCCC – James to relieve lymphedema. Below is a summary of the article and some notes about the use of microsurgery for lymphedema in Canada. The complete article can be found in their magazine, Turning Cancer Discoveries Into Treatment Frontiers – Winter 2017 (starting at page 18) which is available on the web.

Microsurgery Treatments For Lymphedema

Two different approaches are being used:
They cite a review article on the different treatments for lymphedema, where these surgical techniques are described (Plast Reconstr Surg. 2016 Sep;138(3 Suppl):209S-18S). The results look impressive. At the Ohio center, surgeon Dr Skoracki may do the transplanting at the same time as the mastectomy and node removal, to lower the risk of developing lymphedema!

In lymphatic venous anastomosis (LVA), using microsurgical techniques the surgeons create tiny shunts between lymphatic channels and blood vessels that carry fluid around the blocked areas. The rerouted fluid is then dumped into the bloodstream, which has the capacity to take on significantly greater amount of fluid than it usually carries.

LVA is not an option for patients that have no functioning lymphatic channels to connect to in the affected area. These patients may be candidates for vascularized lymph node transfer (VLNT), or lymph node transplant, a newer technique: Lymph nodes from the mesentery are removed and attached to the blood supply in the affected area. Then the lymph nodes themselves sprout connections and release substances (VEGF-C) which attract the growth of lymphatic channels toward them. This recreates a functioning lymphatic system, by replacing the lymph nodes that were removed during the mastectomy.

LVA and VLNT cannot be applied to all lymphedema patients. Morbidly obese patients, or patients with late stage lymphedema, which is characterized by little remaining fluid and much fibrosis. In this case, the swelling is due to fat overgrowth, a side effect of lymphedema.

Surgery for lymphedema is becoming available in several centers but not sure it is available in Canada yet. However, as young microsurgery clinicians are being trained, it is quite likely that it will become available in Canada too in the near future. This is great news for lymphedema sufferers, a condition that, although not life-threatening in most cases, it can be quite debilitating.